Utilization Review Coordinator - Quality Department

The Position

Bargaining Unit: Local 21 - Non-Supervisory Management
CLOSING DATE: May 10, 2024.

Why Join Contra Costa Health?

Contra Costa Regional Medical Center (CCRMC) and Health Centers (HCs) are located in beautiful Contra Costa County across the bay waters from San Francisco and Marin Counties. CCRMC is a public hospital and health system that is dedicated to improving the health of the community.

The Utilization Review unit is part of the Quality department. The Utilization Review unit consists of discharge planning, utilization management, and case management. The Quality Department consists of a group of dynamic and dedicated individuals focused on the improvement of quality of care, patient safety, and regulatory compliance in the acute care and ambulatory settings. There is heavy collaboration with multiple disciplines to design, monitor, and improve processes. Staff at CCRMC and HCs are truly collaborative and respectful!

We are looking for someone who:

• Has strong analytical skills which include prospective, concurrent, and retrospective reviews that use evidence-based guidelines.
• Is strong in communication with the physician reviewer, attending physicians, and other healthcare professionals, as well as reporting important utilization review trends and problems.
• Is an innovative problem-solver during discharge assessments at the time of admission and discharge needs.
• Is proactive and a self-starter with the ability to also work collaboratively as part of a team.
• Maintains a calm demeanor, exercises compassion, and manages stress effectively.

What you will typically be responsible for:

• Determining if the conditions of patients and clinical findings meet the acute hospital criteria.
• Determining if patients cooperate with the required acute level of services and care, as well as monitoring for timeliness and appropriateness of the delivery for quality and safety of care.
• Assessing discharge planning needs and reporting cases that require physician review for inappropriate utilization of resources and/or questionable quality of care.
• Supporting Medical Staff peer review that includes case identification and meeting support.
• Ensuring regulatory compliance and continuous survey readiness.
• Designing and performing audits, observations, rounds, and tracers to evaluate regulatory compliance and quality of care, as well as identify opportunities for improvement.
• Serving as a resource to others in the organization on regulations and performance improvement.

A few reasons why you might love this job:

• You have the opportunity to impact the lives of a vulnerable patient population.
• This is a dynamic organization with a highly dedicated and diverse team of professionals who value the service of others.
• The organization prioritizes quality improvement, creativity, and life-long learning.
• You will have job stability and opportunities for career growth.
• The County offers fantastic and competitive health benefits, paid vacation/sick/personal leave, and a great retirement plan! Check them out here: Employee Benefits | Contra Costa County, CA Official Website
• You will be a member of a strong Union that supports its members! Here’s Local 21’s Memorandum of Understanding (MOU) LOCAL-21-MOU-FOR-2022-2026
• Do you have student loans? Public Service Loan Forgiveness (PSLF) is the most common way people apply to have their student loans forgiven. The County is a qualified employer!

A few challenges you might face in this job:

• You will work in a fast-paced environment that provides support for team members who provide direct services to populations that have complex needs.
• You will encounter days where you must balance your own workload and provide support to team members.
• You must quickly change the prioritization of work as short or long-term projects arise with strict deadlines.

Competencies Required:

• Analyzing & Interpreting Data: Drawing meaning and conclusions from quantitative or qualitative data
• Fact Finding: Obtaining facts and data pertaining to an issue or question
• Legal & Regulatory Navigation: Understanding, interpreting, and ensuring compliance with laws and regulations
• Safety Focus: Showing vigilance and care in identifying and addressing health risks and safety hazards
• Attention to Detail: Focusing on the details of work content, work steps, and final work products
• Self-Management: Showing personal organization, self-discipline, and dependability
• Writing: Communicating effectively in writing
• Involving Others (Engaging Teams): Engaging others for input, contribution, and shared responsibility for outcomes
• Group Facilitation: Enabling constructive and productive group interaction
• Managing & Facilitating Change: Addressing key factors that influence successful organizational change
• Leveraging Technology: Applying technology for improvements in organizational efficiency and effectiveness
• Project Management: Ensuring that projects are on-time, on-budget, and achieve their objectives
• Strategic Thinking & Perspective: Evaluating immediate actions in context of achieving long range objective

To read the complete job description, please visit the website: https://www.cccounty.us/hr .

The eligible list established may fill future vacancies from this recruitment and may remain in effect for six (6) months.

Minimum Qualifications

**PLEASE ATTACH PROOF OF YOUR LICENSE AND EDUCATION (DEGREE AND/OR TRANSCRIPTS) TO YOUR APPLICATION**

License Required: Candidates must possess and maintain throughout the duration of employment a current, valid and unrestricted license as a Registered Nurse in the State of California.

Contra Costa County Regional Medical Center Assignment:

Experience: Two (2) years of full-time (or the equivalent of full-time) experience as a Registered Nurse in an acute care hospital.

Substitution: Possession of a bachelor's degree in nursing may be substituted for six (6) months of the required experience except in the Public Health assignment.

Desirable Qualifications:

• Training or experience in Quality Improvement methodologies
• Ability to analyze data
• Computer literacy with advanced skills in Excel and EPIC
• Organized succinct writing and presentation skills
• Ability to prioritize and manage multiple projects
• In-depth knowledge of regulations impacting healthcare organizations

Selection Process

1. Application Filing and Evaluation : All applicants will be required to complete a supplemental questionnaire at the time of application. Applications will be evaluated to determine which candidates will move forward in the next phase of the recruitment process.

2. Training and Experience Evaluation: At the time of filing, within the supplemental questionnaire, candidates will be required to complete a training and experience questionnaire. Candidates who clearly meet the minimum qualifications, as described above, will have their training and experience responses evaluated, which will determine their score and rank on the eligible list. The training and experience questionnaire is designed to measure the candidate’s relevant education, training, and/or experience as it relates to the position. (Weighted 100%).

3. Final Selection Interviews: The hiring manager interviews will be scheduled directly by the unit/division once the eligible list is established.

The Human Resources Department may change the examination steps noted above in accordance with the Personnel Management Regulations and accepted selection practices.

For recruitment questions, please contact Health Services Personnel, Recruitment Team at Exams@cchealth.org . For any technical issues, please contact the GovernmentJobs’ applicant support team for assistance at +1-855-524-5627.

CONVICTION HISTORY

After you receive a conditional job offer, you will be fingerprinted, and your fingerprints will be sent to the California Department of Justice (DOJ) and the Federal Bureau of Investigation (FBI). The resulting report of your conviction history (if any) will be used to determine whether the nature of your conviction conflicts with the specific duties and responsibilities of the job for which you have received a conditional job offer. If a conflict exists, you will be asked to present any evidence of rehabilitation that may mitigate the conflict, except when federal or state regulations bar employment in specific circumstances. Having a conviction history does not automatically preclude you from a job with Contra Costa County. If you accept a conditional job offer, the Human Resources Department will contact you to schedule a fingerprinting appointment.

DISASTER SERVICE WORKER

All Contra Costa County employees are designated Disaster Service Workers through state and local law. Employment with the County requires the affirmation of a loyalty oath to this effect. Employees are required to complete all Disaster Service Worker-related training as assigned, and to return to work as ordered in the event of an emergency.

EQUAL EMPLOYMENT OPPORTUNITY

It is the policy of Contra Costa County to consider all applicants for employment without regard to race, color, religion, sex, national origin, ethnicity, age, disability, sexual orientation, gender, gender identity, gender expression, marital status, ancestry, medical condition, genetic information, military or veteran status, or other protected category under the law.

To find more information on Benefits offered by Contra Costa County, please go to https://www.contracosta.ca.gov/1343/Employee-Benefits

Closing Date/Time: 5/10/2024 11:59 PM Pacific

Martinez, California United States View Map